NPI | 1275186959 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: TX 1096576) |
Additional Taxonomies | 163W00000X Registered Nurse (Licence: TX 957975) |
Enumeration Date | 2019-07-22 |
Last Update Date | 2022-11-29 |